Method of enhanced distribution of pharmaceuticals in long-term care facilities

ABSTRACT

Methods of enhanced distribution of pharmaceuticals in long-term care facilities are provided. An embodiment of a method includes positioning two or more pharmaceutical storage and electronic dispensing machines each positioned in a different long-term care facility remote from a long-term care facility pharmacy group management server and in communication therewith, and long-term care facility pharmacy management computer programs associated with the long-term care facility pharmacy group management server to enhance use of the one or more of pharmaceutical storage and electronic dispensing machines. The long-term care facility management computer programs include a patient prescription receiver and a medication dispensing apparatus administrator and are configured and operable to transmit dispensing instructions to the one or more pharmaceutical storage and electronic dispensing machines when no drug conflicts exist to thereby initiate packaging and dispensing of one or more disposable patient dosing packages.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/077,403, filed Mar. 22, 2016, titled “System of Enhanced Distributionof Pharmaceuticals in Long-Term Care Facilities,” which is acontinuation of U.S. patent application Ser. No. 15/001,498, filed Jan.20, 2016, titled “System and Method of Enhanced Distribution ofPharmaceuticals in Long-Term Care Facilities,” which is a continuationof U.S. patent application Ser. No. 14/589,174, filed Jan. 5, 2015,titled “System And Method Of Enhanced Distribution Of Pharmaceuticals InLong-Term Care Facilities,” which is continuation of U.S. patentapplication Ser. No. 14/075,461, filed Nov. 8, 2013, now U.S. Pat. No.8,954,338, issued Feb. 10, 2015, titled “System And Method Of EnhancedDistribution Of Pharmaceuticals In Long-Term Care Facilities,” which isa continuation of U.S. patent application Ser. No. 14/014,796, filedAug. 30, 2013, now U.S. Pat. No. 8,612,256, issued Dec. 17, 2013, titled“System And Software Of Enhanced Pharmaceutical Operations In Long-TermCare Facilities And Related Methods” which is a continuation of U.S.patent application Ser. No. 13/725,432, filed Dec. 21, 2012, now U.S.Pat. No. 8,554,574, issued Oct. 8, 2013, titled “System And Software OfEnhanced Pharmaceutical Operations In Long-Term Care Facilities AndRelated Methods” which is a divisional of U.S. patent application Ser.No. 13/454,624, filed Apr. 24, 2012, now U.S. Pat. No. 8,489,425, issuedJul. 16, 2013, titled “System and Software of Enhanced PharmaceuticalOperations in Long-Term Care Facilities and Related Methods,” which is acontinuation of U.S. patent application Ser. No. 11/818,416, filed Jun.14, 2007, now U.S. Pat. No. 8,260,632, issued Sep. 4, 2012, titled“System and Software of Enhanced Pharmaceutical Operations in Long-TermCare Facilities and Related Methods,” which is a divisional of U.S.patent application Ser. No. 10/944,993, filed Sep. 20, 2004, now U.S.Pat. No. 7,698,019, issued Apr. 13, 2010, titled “System and Software ofEnhanced Pharmaceutical Operations in Long-Term Care Facilities andRelated Methods,” which claims priority of U.S. Provisional ApplicationSer. No. 60/516,678, filed Nov. 3, 2003, titled “System and Software ofEnhanced Pharmaceutical Operations in Long-Term Care Facilities andRelated Methods,” each incorporated herein by reference in its entirety.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to the nursing home, retirement home, assistedliving facility, and other long-term care industries in general and,more particularly, to pharmaceutical operations within nursing homes,retirement homes, assisted living facilities, and other long-term carefacilities.

2. Description of Related Art

Over the years, pharmacies have been a backbone in providingprescription drugs and other medications to people and have been aconvenience as retail pharmacies have expanded to locating close to mostresidential areas in our country. Recently, pharmacies also have beenplaced inside of facilities such as hospitals, physician offices, malls,nursing homes, retirement homes, assisted living facilities, and otherlocations to make it easier for people to get access to medications andto facilitate interaction with medical personnel. Because of thenumerous types of medications stored and dispensed by pharmacies,automation within the pharmacy industry has been desirable. Accordingly,numerous developments have been made to automate the pharmacy ordering,dispensing, and storage capabilities. For example, machines have beendeveloped to store and dispense medication responsive to security codesor other identification from medical personnel or users. Also,electronic storage and dispensing carts have been developed which areoften stored on each floor of a hospital to allow the carts toelectronically receive dispensing instructions from a hospital pharmacycomputer. Additionally, machines have been developed to store severalhundred different types of medications and to dispense the medicationsto medical personnel for distribution to patients.

Nevertheless, little has been done to enhance storage and distributionof medications in nursing homes, retirement homes, Alzheimer's livingfacilities, senior communities, assisted living facilities, and othertypes of long term care facilities (hereinafter collectively “long-termcare facilities”) which are significantly different in operation,personnel structure, and physical structure than hospitals, physicianoffices, and home care. This is increasingly important as the baby boomgeneration ages and more and more people enter these long-term carefacilities. Also, because more and more people are and will be enteringthese long-term care facilities and because medication costs have beenrising over the years, attempting to help make pharmacies, providingservices to these long term facilities, profitable can often beimportant in successfully operating a long-term care facility. Further,error can arise when dispensing medication, and a need still exists toreduce the risk of error in dispensing medication, especially inlong-term care facilities.

SUMMARY OF THE INVENTION

In view of the foregoing, embodiments of the present inventionadvantageously provide a system, software and methods for enhancingpharmaceutical distribution in nursing homes, assisted livingfacilities, retirement homes, and other long-term care facilities.Embodiments of the present invention also advantageously provide asystem, software, and methods for enhanced pharmaceutical distributionin long-term care facilities that substantially reduces medicationshortages, reduces medication preparation time, reduces medicationpassing or dispensing time, reduces medication waste, enhancesdocumentation, and enhances regulatory acceptance. Embodiments of thepresent invention additionally provide a system, software, and methodsfor enhanced pharmaceutical operations in long-term care facilities,which substantially reduce the risk of error associated with dispensingmedications to patients in the homes or facilities. Embodiments of thepresent invention further provide a system, software, and methods forenhanced pharmaceutical operations in long-term care facilities, whichenhance profitability of pharmacy business associated with the homes orfacilities. Embodiments of the present invention still further provide asystem, software, and methods for enhanced pharmaceutical operations,which streamline the medication dispensing procedures for medicalpersonnel working with the long-term care facilities to help make theprocedures more efficient and easier.

More particularly, embodiments of the present invention provide a systemof enhanced pharmaceutical distribution for long-term care facilities.According to an embodiment, a system to facilitate enhanced use of oneor more pharmaceutical storage and electronic dispensing machines in oneor more long-term care facilities is in communication with acommunication network and one or more remote long-term care facilitypharmacy management servers. The system includes one or morepharmaceutical storage and electronic dispensing machines positioned ateach of one or more long-term care facilities. Each of the one or morepharmaceutical storage and electronic dispensing machines is positionedremote from, and adapted to be in communication with, one or morelong-term care facility pharmacy management servers associated with along-term care facility remote pharmacy via a communications network.The one or more long-term care facility pharmacy management serversinclude non-transitory, tangible memory medium to store long-term carefacility management computer programs. The long-term care facilitymanagement computer programs include a patient prescription receiver toreceive a patient medication prescription order and a medicationdispensing apparatus administrator to selectively remote control one ormore pharmaceutical storage and electronic dispensing machine functions.The computer programs are also configured and operable to verify, at thelong-term care facility remote pharmacy, one or more patient medicationprescription orders received from one or more pharmaceuticalprescription document processors when positioned in communication withone of the one or more pharmaceutical storage and electronic dispensingmachines to thereby enhance reduction of medication order errors. Thecomputer programs are also configured and operable to compare one ormore digital images of the one or more patient medication prescriptionorders with one or more of a patient medication profile, a patientdiagnosis profile, and a drug interaction profile, to thereby enhancereduction of drug conflicts. The computer programs are also configuredand operable to determine, responsive to the one or more patientmedication prescription orders, whether drug conflicts exist. Thecomputer programs are also configured and operable to transmitdispensing instructions to the one or more pharmaceutical storage andelectronic dispensing machines via the communications network when nodrug conflicts exist to thereby initiate packaging and dispensing of oneor more disposable patient dosing packages at the one or morepharmaceutical storage and electronic dispensing machines.

For example, in another embodiment of the present invention, a systemincludes a first data processing and management computer including afirst memory to store data therein to thereby define a long-term carefacility pharmacy group management server. Long-term care facilitypharmacy management software stored in the first memory of the long-termcare facility pharmacy group management server manages pharmaceuticaloperations in long-term care facilities. A plurality of pharmaceuticalstorage and electronic dispensing carts are each positioned in aseparate long-term care facility remote from the long-term care facilitypharmacy group management server and are in communication with thelong-term care facility pharmacy group management server though acommunication network to store pharmaceuticals therein and to dispensethe pharmaceuticals to authorized healthcare personnel located at thelong-term care facility. A second remote pharmacy group computer ispositioned remote from and in communication with the long-term carefacility pharmacy group management server, and is positioned remote fromand in communication with the plurality of pharmaceutical storage andelectronic dispensing carts. The second remote pharmacy group computerincludes a second memory to store data therein to define a remotepharmacy group server. A plurality of pharmaceutical prescriptiondocument processors are each positioned in the long-term care facilitywhere at least one of the plurality of pharmaceutical storage andelectronic dispensing carts is located and are in communication with theremote pharmacy group server or the pharmacy group management server toprocess a pharmaceutical prescription order from the long-term carefacility to be delivered to the long-term care facility for storage anddispensing through the at least one of the plurality of pharmaceuticalstorage and electronic dispensing carts. The system can also include aplurality of video input devices each separately positioned adjacent arespective one of the plurality of pharmaceutical storage and electronicdispensing carts remote from and in communication with at least one ofthe long-term care facility pharmacy group management server and theremote pharmacy group server. Each video input device is positionable toproduce a video image of facility health care personnel and preferablyis positionable to view visually accessible functional components of theadjacent pharmaceutical storage and electronic dispensing cart. Thisallows for the provision of visual feedback to pharmacy personnel toallow for enhanced training facility health-care personnel and fortroubleshooting the pharmaceutical storage and electronic dispensingcart. The system also can include a pharmaceutical storage facilityassociated with the remote pharmacy group server and having a pluralityof pharmaceuticals stored therein. The pharmaceutical storage facilityhas at least one vehicle to facilitate delivery of the pharmaceuticalsat the storage facility to each of the plurality of pharmaceuticalstorage and electronic dispensing carts at the plurality of long-termcare facilities responsive to the pharmaceutical prescription order.

Also, for example, in an embodiment of the present invention, a systemcan include a pharmacy group management computer defining a long-termcare facility pharmacy group management server, and long-term carefacility pharmacy management software associated with the long-term carefacility pharmacy group management server to manage pharmaceuticaloperations in a plurality of long-term care facilities. A plurality ofpharmaceutical storage and electronic dispensing carts are eachpositioned in a long-term care facility separate and remote from thelong-term care facility pharmacy group management server to storepharmaceuticals therein and to dispense the pharmaceuticals toauthorized health care personnel located at the long-term care facility.The plurality of pharmaceutical storage and electronic dispensing cartsand a plurality of pharmaceutical prescription document processors areeach positioned in a long-term care facility remote separate from and incommunication with the long-term care facility pharmacy group managementserver or a remote pharmacy group computer or server to process apharmaceutical prescription order from the long-term care facility andto be delivered to the long-term care facility.

Additionally, according to an embodiment of the present invention, asystem can include a first pharmacy group management computer defining along-term care facility pharmacy group management server and long-termcare facility pharmacy management software associated with the long-termcare facility pharmacy group management server to manage pharmaceuticaloperations in a plurality of long-term care facilities. A plurality ofpharmaceutical storage and electronic dispensing carts are eachpositioned in one of the plurality of long-term care facilities remotefrom the long-term care facility pharmacy group management server and incommunication with the long-term care facility pharmacy group managementserver to store a plurality of different pharmaceuticals, package aplurality of individual doses of pharmaceuticals, and dispense theplurality of individual doses of pharmaceuticals to authorized facilitymedical personnel located at one of the plurality of long-term carefacilities. A remote pharmaceutical dispensing and storage facility ispositioned remote from the plurality of pharmaceutical storage andelectronic dispensing carts and is associated with a second remotepharmacy group computer defining a remote pharmacy group server which isalso in communication with the long-term care facility pharmacy groupmanagement server and each of the plurality of pharmaceutical storageand electronic dispensing carts through the communication network. Theremote pharmaceutical dispensing storage facility has a plurality ofpharmaceuticals stored therein and has at least one vehicle positionedto deliver selected pharmaceuticals at the storage facility to each ofthe plurality of pharmaceutical storage and electronic dispensing carts.Delivery, preferably along a preplanned or preselected delivery route,is accomplished in response to a combination of individual facilitypatient pharmaceutical dispensing instructions and medication inventoryfor each of the plurality of pharmaceutical storage and electronicdispensing carts.

Embodiments of the present invention provide long-term care facilitypharmacy management software adapted to be stored on the storage media.For example, in an embodiment of the present invention, the softwareincludes a patient prescription receiver which receives a digital imageof a patient medication prescription order from a pharmaceuticalprescription document processor associated with a remote medicationdispensing apparatus, such as the above described pharmaceutical storageand dispensing device, to store the digital image of the patientmedication prescription and to queue the digital image for prescriptionorder processing. A queue receives the digital image and holds thedigital image for prescription order requirements entry and releaseverification by a remote pharmacy pharmacist. A drug conflict analyzer,responsive to the prescription order requirements and data containedwithin the patient record, can analyze the prescription orderrequirements against a patient medication profile, a patient allergyprofile, a patient diagnosis profile, a patient insurance profile, and adrug interaction profile, to determine if a conflict exists. If noconflict is found, a dispensing initiator positioned to receive themedication inventory for each of the pharmaceutical storage andelectronic dispensing carts and responsive to the release verificationperformed by the remote pharmacy pharmacist, can transmit individualfacility patient pharmaceutical dispensing instructions to therespective pharmaceutical storage and electronic dispensing cart overthe communication network to thereby initiate patient medicationdispensing.

Also, for example, in an embodiment of the present invention, thesoftware is adapted to be stored on a storage media associated with apharmacy group management computer to manage pharmaceutical operationsin a remote pharmaceutical dispensing and storage facility and aplurality of remotely positioned long-term care facilities each having amedication dispensing apparatus. The software is further adapted toaccept prescriptions from a physician, patient identificationinformation and pharmaceutical inventory from the medication dispensingapparatus, and insurance information from the patient's insurancecompany. This allows the software to control dispensing medication fromthe medication dispensing apparatus to an authorized health-carepersonnel in each of the long-term care facilities, to control inventoryin the medication dispensing apparatus, to order delivery ofpharmaceuticals from the remote pharmaceutical dispensing and storagefacility to restock the medication dispensing apparatus or forindividually tailored prescription delivery for those prescriptions notstocked in the medication dispensing apparatus, and to electronicallyprocess medication claims with a reimbursement provider.

Further, embodiments of the present invention also can include acomputer readable medium that is readable by a computer to managepharmaceutical operations in a remote pharmaceutical dispensing andstorage facility defining a remote pharmacy and in a plurality ofremotely positioned long-term care facilities each having at least oneremote pharmaceutical dispensing and storing apparatus in communicationwith the computer and having a memory and a plurality of medicationdispensing cartridges associated therewith. In the preferred embodimentof the present invention, the computer readable medium includes a set ofinstructions that, when executed by the computer, cause the computer toperform the following operations: establishing remote communicationsbetween each pharmaceutical storage and dispensing apparatus and theremote pharmacy, registering at least one patient for each of theplurality of long-term care facilities in a database of residents forthe long-term care facility associated with a pharmaceutical storage anddispensing apparatus located at that long-term care facility, storing inmemory of each pharmaceutical storage and dispensing apparatus at leastone medication type, an amount of medication to be dispensed, and amedication dispensing time, dispensing medication responsive to patientprescription requirements for each patient registered to thepharmaceutical storage and dispensing apparatus located at eachrespective long-term care facility, and maintaining a record ofmedication dispensed and an inventory of medication remaining in eachcartridge of each pharmaceutical storage and dispensing apparatus.

Embodiments of the present invention also include methods of enhancedpharmaceutical distribution in long-term care facilities. For example,an embodiment is a method of distributing pharmaceuticals in one or morelong-term care facilities through one or more pharmaceutical storage andelectronic dispensing machines positioned in each long-term carefacility when in communication with a communication network and one ormore remote long-term care facility pharmacy management servers. Themethod includes positioning one or more pharmaceutical storage andelectronic dispensing machines at each long-term care facility such thateach pharmaceutical storage and electronic dispensing machine isoperable by one or more long-term care facility staff members and ispositioned remote from, and adapted to be in communication with, one ormore long-term care facility pharmacy management servers associated witha long-term care facility remote pharmacy via a communications network.The one or more long-term care facility pharmacy management serversinclude non-transitory, tangible memory medium to store long-term carefacility management computer programs including a patient prescriptionreceiver to receive a patient medication prescription order and amedication dispensing apparatus administrator to selectively remotecontrol one or more pharmaceutical storage and electronic dispensingmachine functions. The method further includes verifying, at thelong-term care facility remote pharmacy, one or more patient medicationprescription orders received from one or more pharmaceuticalprescription document processors adapted to be in communication with oneof the one or more pharmaceutical storage and electronic dispensingmachines to thereby enhance reduction of medication order errors. Themethod further includes processing the one or more patient medicationprescription orders responsive to one or more pharmaceuticalprescription document processors for confirmation by one or morelong-term care facility remote pharmacy personnel. The method furtherincludes comparing, via the long-term care facility management computerprograms, the one or more patient medication prescription orders withone or more of a patient medication profile, a patient diagnosisprofile, and a drug interaction profile, to thereby enhance reduction ofdrug conflicts. The method further includes determining, responsive tothe one or more patient medication prescription orders, whether drugconflicts exist. The method further includes transmitting dispensinginstructions to the one or more pharmaceutical storage and electronicdispensing machines by the long-term care facility management computerprograms via the communications network when no drug conflicts exist tothereby initiate dispensing of one or more disposable individual patientdosing packages at the one or more pharmaceutical storage and electronicdispensing machines. The method further includes packaging, by the oneor more pharmaceutical storage and electronic dispensing machines, oneor more medications into one or more disposable individual patientdosing packages.

Another embodiment of a method includes providing a pharmacy remote froma plurality of long-term care facilities to define an long-term carefacility pharmacy, restructuring long-term care facility staffprocedures for communication between long-term care facility staff andthe long-term care facility pharmacy, restructuring medicationprocurement and resident medication distribution procedures within theplurality of long-term care facilities, installing a pharmaceuticalstorage and electronic dispensing cart at each of the plurality of thelong-term care facilities to be used by the long-term care facilitystaff, and visiting each of the plurality of long-term care facilitieson a preselected frequency by pharmacy staff from the remote pharmacy toassess performance and enhance communication.

By restructuring long-term care facility staff communication proceduresand medication procurement and patient distribution procedures,embodiments of the present invention advantageously enhancepharmaceutical operations by allowing an individual long-term carefacility to participate in a broader network of a plurality of long-termcare facilities to thereby participate in costing and delivery benefitsof the plurality or group of long-term care facilities. Such groupparticipation streamlines operational procedures and communication andenhances profitability of the individual long-term care facilities.

Embodiments of the present invention also include methods for generatingrevenue from a plurality of long-term care facilities each devoid of anon-location pharmacy. For example, in an embodiment of the presentinvention, a method includes reducing management overhead costs andreducing pharmaceutical delivery costs. Management overhead costs can bereduced by assigning each of the plurality of long-term care facilitiesat least one automated pharmaceutical storage and dispensing cart toreduce workload of facility staff members, assigning a plurality of thelong-term care facilities to each of at least one long-term carefacility remote pharmacy, and assigning the at least one long-term carefacility remote pharmacy to a single long-term care facility pharmacygroup manager, to thereby continuously monitor multiple long-term carefacilities. Pharmaceutical delivery costs can be reduced by deliveringpharmaceuticals by long-term care facility remote pharmacy vehicle toreplenish, in a single delivery iteration, each of a plurality of theautomated pharmaceutical storage and dispensing carts and to providethose pharmaceuticals according to the patient prescription requirementsand not provided by each respective pharmaceutical storage andelectronic dispensing cart.

Still further, in an embodiment of the present invention, a methodincludes providing a pharmacy remote from a plurality of long-term carefacilities to define a long-term care facility remote pharmacy,positioning at least one pharmaceutical storage and dispensing apparatushaving at least one removable medicine cartridge in each of theplurality of long-term care facilities to store and dispensepharmaceuticals to a patient living therein, and establishing remotecommunications between each pharmaceutical storage and dispensingapparatus and the remote pharmacy. This results in a generation ofrevenue due to cost savings for both the pharmacy and the long-term carefacilities and secures a stable level of sales. Patients for each of theplurality of long-term care facilities are then registered in a databaseof residents for the long-term care facility associated with arespective pharmaceutical storage and dispensing apparatus located atthat long-term care facility, the database stored in memory of a dataprocessing and management computer. At least one medication type, amountto be dispensed, and a medication dispensing time is then remotelyprogrammed into each pharmaceutical storage and dispensing apparatus,and medication is dispensed according to patient prescriptionrequirements for each associated registered patient. An inventory ofmedication dispensed and medication remaining can be maintained in thepharmaceutical storage and dispensing apparatus and transmitted directlyor indirectly to the remote pharmacy to allow for just-in-time typeresupply of the pharmaceutical storage and dispensing apparatus.Further, separate billing records along with consolidated billing datacan be supplied for each plurality of registered patients at each of theplurality of long-term care facilities. The methodology allows for theconsolidated billing data to be organized by patient, facility, remotepharmacy, and reimbursement provider. This again reduces overhead to thepharmacy and the facility and can allow for batch-type processing by areimbursement provider.

BRIEF DESCRIPTION OF THE DRAWINGS

So that the manner in which the features and benefits of the invention,as well as others which will become apparent, may be understood in moredetail, a more particular description of the invention brieflysummarized above may be had by reference to the embodiments thereofwhich are illustrated in the appended drawings, which form a part ofthis specification. It is to be noted, however, that the drawingsillustrate only various embodiments of the invention and are thereforenot to be considered limiting of the invention's scope as it may includeother effective embodiments as well.

FIG. 1A is a schematic block diagram of a plurality of remote pharmacygroup computers networked to a remote pharmacy group management serverof a system and software for enhanced pharmaceutical operations inlong-term care facilities according to an embodiment of the presentinvention;

FIG. 1B is a schematic block diagram of a remote pharmacy group computernetworked to a plurality of long-term care facilities of a system andsoftware for enhanced pharmaceutical operations in long-term carefacilities according to an embodiment of the present invention;

FIG. 2 is an environmental perspective view of a medication storage anddispensing apparatus and a long-term care facility operational diagramof a system, software, and method for enhanced pharmaceutical operationsin a long-term care facility according to an embodiment of the presentinvention;

FIG. 3 is an environmental perspective view of medical personnel using amedication storage and dispensing apparatus of a system, software, andmethod of enhanced pharmaceutical operations in long-term carefacilities according to an embodiment of the present invention;

FIG. 4A is a perspective view of a medication dispensing tray/caddie ofa medication storage and dispensing apparatus of a system for enhancedpharmaceutical operations according to an embodiment of the presentinvention;

FIG. 4B is a perspective view of one of the medication dispensingenvelopes in the medication dispensing tray/caddie of FIG. 4A accordingto an embodiment of the present invention;

FIG. 5 is a top plan view of a long-term care facility of a system andmethod of enhanced pharmaceutical operations in long-term carefacilities according to an embodiment of the present invention;

FIG. 6 is a schematic flow diagram of a method of enhancedpharmaceutical operations in a long-term care facility according to anembodiment of the present invention;

FIG. 7 is a schematic block diagram of a system and software forenhanced pharmaceutical operations of long-term care facilitiesaccording to the present invention;

FIG. 8A is a partial schematic flow diagram of software and methods forenhanced pharmaceutical operations in long-term care facilitiesaccording to an embodiment of the present invention;

FIG. 8B is a partial schematic flow diagram of software and methods forenhanced pharmaceutical operations in long-term care facilitiesaccording to an embodiment of the present invention;

FIG. 8C is a schematic block diagram of database software of a systemfor enhanced pharmaceutical operations in long-term care facilitiesaccording to an embodiment of the present invention;

FIG. 9 is a schematic diagram of a system for enhanced pharmaceuticaloperations in long-term care facilities according to an alternativeembodiment of the present invention;

FIG. 10 is a partial schematic diagram of software to enhancepharmaceutical operations in long-term care facilities according to anembodiment of the present invention;

FIG. 11 is a schematic flow diagram of a method of generating revenuefrom a plurality of long-term care facilities devoid of an on-locationpharmacy according to an embodiment of the present invention; and

FIGS. 12A-C are schematic flow diagrams of a method of increasing salesto and generating revenue from a plurality of long-term care facilitiesbeing devoid of an on-location pharmacy according to an embodiment ofthe present invention.

DETAILED DESCRIPTION

The present invention now will be described more fully hereinafter withreference to the accompanying drawings, which illustrate embodiments ofthe invention. This invention may, however, be embodied in manydifferent forms and should not be construed as limited to theillustrated embodiments set forth herein. Rather, these embodiments areprovided so that this disclosure will be thorough and complete, and willfully convey the scope of the invention to those skilled in the art.Like numbers refer to like elements throughout. Prime notation, if used,indicates similar elements in alternative embodiments.

FIGS. 1A-1B illustrate a system 10 of enhanced pharmaceutical operationservices for long-term care facilities 12 according to an embodiment ofthe present invention that includes a data processing and managementcomputer including a memory 21 to store data therein thereby to define along-term care facility pharmacy group management server 15, long-termcare facility pharmacy management software 20 stored in the memory 21 ofthe long-term care facility pharmacy group management server 15 tomanage pharmaceutical operations in long-term care facilities 12, and acommunications network 18 in communication with the long-term carefacility pharmacy group management server 15. An alternative embodimentof such a system 10′ is illustrated in FIG. 9 as well.

As perhaps best shown in FIGS. 2-5, the system 10 also includes aplurality of pharmaceutical storage and electronic dispensing machinesor carts 30 each positioned in a separate long-term care facility 12remote from the long-term care facility pharmacy group management server15 and in communication with the long-term care facility pharmacy groupmanagement server 15 through the communication network 18 to storepharmaceuticals therein and to dispense the pharmaceuticals toauthorized health care personnel located at the long-term care facility12. Each of the plurality of pharmaceutical storage and electronicdispensing machines or carts 30 store a plurality of differentpharmaceuticals, e.g., 176 oral solid medications as well as additionalbulk storage capabilities, package a plurality of individual doses ofpharmaceuticals, dispense the plurality of individual doses ofpharmaceuticals to authorized healthcare personnel at the long-term carefacilities, and are well understood by those skilled in the art. Anexample of such a pharmaceutical storage and electronic dispensingmachine or cart 30, as understood by those skilled in the art, is thePyxisEnvoy™ by Pyxis Corporation of San Diego, Calif. The PyxisEnvoy,for example, is a dispensing machine capable of securely storing bulkmedication for automated patient-specific dispensing. The PyxisEnvoy iscapable of packaging medications in individual patient-specificenvelopes, both on-demand or at a predetermined time interval, and canorganize the patient's envelopes into medication carriers. The envelopescan be further organized whereby “first dose” medications and PRNmedications are positioned into separate medication carriers. Further,each envelope can be labeled by the machine with the patient's name,room number, medication, and strength. The PyxisEnvoy can store bulkmedications in refill cartridges and containers providing an on-sitereserve supply of medications. The PyxisEnvoy, for example,advantageously has the necessary hardware to be remotely controllablefrom an off-site location and the ability to receive or interface withadditional software. As will be understood by those skilled in the art,other types of dispensing carts can be used as well according to thepresent invention.

Each of the pharmaceutical storage and electronic dispensing machines orcarts 30 has associated software which interfaces with and communicateswith the pharmacy group management software 20 so that once preselectedblock times and other system parameters of the embodiments of thepresent invention are implemented, data entry can be performed by apharmacy remote from the long-term care facility 12. Also, oncepreselected block times are established, the pharmaceutical storage andelectronic dispensing machines or carts 30 can automatically, i.e.responsive to predetermined commands in memory, package all scheduledmedications and perform a regularly scheduled catch-up run to processnew or changed medication orders.

As understood by those skilled in the art, these machines or carts 30package medication in patient specific envelopes sorted in a preselectedorder, e.g., an order specified by the long-term care facility 12.Advantageously, there is no need to punch medications out of a blisterpack into a cup or to search an entire medication cart for a vial ofmedication, e.g., that someone forgot to reorder. Because thesepharmaceutical storage and electronic dispensing machines or carts 30can store large amounts, e.g., 176, of different medications and candispense these medications, long-term care facilities 12 do not have toconstantly reorder medications. The system 10 and methods maintain aninventory of the number of medications dispensed and number availablefor dispensing. Each container of the 176 working inventory containersincludes a memory chip (not shown), as understood by those skilled inthe art, for such inventory control and lot tracking of the medication.Each machine or cart 30 can have a separate removable medicine cartridge(not shown) for each medication type. The system 10 and methods fillthese machines or carts 30 at preselected intervals, e.g., once a week,or as needed based on current inventory and usage rate.

As shown in FIGS. 1A and 1B, the system 10 additionally can include aremote pharmacy group computer. The remote pharmacy group computer ispositioned remote from the long-term care facility pharmacy groupmanagement server 15, in communication with the long-term care facilitypharmacy group management server 15 and the plurality of pharmaceuticalstorage and electronic dispensing carts 30 through the communicationnetwork 18, and has a memory to store data therein, to define a remotepharmacy group server 40. The remote pharmacy group server 40 ispreferably located in a remote pharmaceutical dispensing and storagefacility defining a remote pharmacy 41.

The system 10 can also include a plurality of pharmaceuticalprescription document processors 14, e.g., facsimile machines, scanners,or other document processing machines, computers, or equipment asunderstood by those skilled in the art, each positioned in a long-termcare facility 12 remote from and in communication with the remotepharmacy group server 40 to process a pharmaceutical prescription orderfrom the long-term care facility 12 to be delivered to the long-termcare facility 12.

Each of a plurality of preferably non-stationary video input devices 31(FIG. 2), such as a digital, analog, or other type of camera, chargecoupled device, digital imaging source, or other device to captureimages, as understood by those skilled in the art, can be positioned inone of the long-term care facilities 12 adjacent and preferablyinterfaced with a respective one of the plurality of pharmaceuticalstorage and electronic dispensing carts 30 remote from and incommunication with at least one of the long-term care facility pharmacygroup management server 15 and the remote pharmacy group server 40. Thevideo input devices 31 are positionable to produce for display over thecommunications network 18 a video image of facility medical personneland visually accessible functional components of the pharmaceuticalstorage and electronic dispensing cart 30, including e.g. theprescription document processor 14. This functionality advantageouslyprovides visual feedback to pharmacy personnel to train the facilitymedical personnel and for troubleshooting the pharmaceutical storage andelectronic dispensing cart 30.

The system 10 can also include a pharmaceutical storage facility 16associated with the remote pharmacy group server 40 and having aplurality of pharmaceuticals stored therein and at least one vehicle Vto facilitate delivery of the pharmaceuticals at the storage facility toeach of the plurality of pharmaceutical storage and electronicdispensing carts 30 at the plurality of long-term care facilities 12,responsive to the pharmaceutical prescription order.

As perhaps best shown in FIGS. 7, 8C, and 10, the long-term carefacility pharmacy management software 20 is particularly adapted toaccept prescriptions from a physician, patient identificationinformation from the long-term care facility, facility information,insurance information from the patient's insurance company, claiminformation, drug utilization review, and pharmaceutical inventory fromthe pharmaceutical storage and dispensing machines or carts 30 (FIG. 2)to control inventory in each of the plurality of pharmaceutical storageand electronic dispensing machines or carts 30 and to order delivery ofpharmaceuticals to restock the dispensing carts 30 or for individuallytailored prescription delivery by the vehicles V (FIG. 1B) for thoseprescriptions not stocked in the dispensing carts 30. The long-term carefacility pharmacy management software 20, for example, also can includeautomated inventory replenishment of the dispensing carts 30, dispensingcart dispensing control, claim processing, prescribed drug conflictanalysis based on patient medication profile, allergies, diagnosis,prescribed drug conflict analysis based on prescribed drug interaction,and prescribed drug analysis based on patient insurance coverage. Note,the software 20 can be in the form of microcode, programs, routines, andsymbolic languages that provide a specific set for sets of orderedoperations that control the functioning of the hardware and direct itsoperation, as known and understood by those skilled in the art.

As shown in FIGS. 1-12C, embodiments of the system 10 include pharmacymanagement software 20 and methods designed to deliver pharmaceuticaloperation services to a plurality of long-term care facilities 12, e.g.,staff and residents, positioned remotely from a pharmacy and utilizing aplurality of pharmaceutical storage and dispensing carts 30 in thelong-term care facility 12, in a manner that significantly enhances thesynergistic relationships of healthcare providers involved in the dailycare of residents. The system 10 advantageously uses hardware, software,and robotics to converge previously disparate healthcare providers atthe resident's side. The financial, social, and medical impact oflong-term care facility providers communicating in real-time or nearreal time with near real-time medication delivery provides significantcost reduction for healthcare payors. It is thought that millions, oreven billions, of dollars of medication are wasted each year due to acombination of poor communication between long-term care providers andprior art medication delivery systems.

As shown in FIG. 10, much of the above identified software 20 can beimplemented utilizing various components or modules. Note, though shownpositioned together, various parts of the software 20, once loaded via acomputer readable medium, can be functionally distributed at variouslocations within the system 10.

In an embodiment of the present invention, the software 20 includes apatient prescription receiver 51 which receives a digital image of apatient medication prescription order from a pharmaceutical prescriptiondocument processor 14 associated with a remote medication dispensingapparatus, such as pharmaceutical storage and dispensing device 30, tostore the digital image of the patient medication prescription and toqueue the digital image for prescription order processing. A patientprescription order transferor 53, preferably stored in memory of thepharmaceutical storage and dispensing device 30 transmits over thecommunication network 18 the digitized image of the patient medicationprescription order received from an associated pharmaceuticalprescription processor 14 to the pharmacy group management server 15 orremote pharmacy group server 40, in response to a release initiated byeither a pharmacy staff member or a facility staff member. This providesthe pharmacy group management server 15 or remote pharmacy group server40 with patient medication requirements which can be stored in database22. Correspondingly, a patient record transferor 55 also preferablystored in the memory of the pharmaceutical storage and dispensing device30 can transmit either a patient record or select portions thereof. Thepatient record generally has fields which can include patientidentification, patient medication profile, patient allergy profile,patient diagnosis profile, and patient insurance profile. Upon receiptof either the entire patient record or select portions thereof, theentire patient record or the select portions can be stored in the memory21 (database 22) of the pharmacy group management server 15.

A queue 57 receives the digital image and holds the digital image forprescription order requirements entry and release verification by aremote pharmacy pharmacist. A drug conflict analyzer 59, responsive tothe prescription order requirements and data contained within thepatient record, can analyze the prescription order requirements againstthe patient medication profile, the patient allergy profile, the patientdiagnosis profile, and patient insurance profile, and a drug interactionprofile, to determine if a conflict exists. If no conflict is found, adispensing initiator 61 positioned to receive the medication inventoryfor each of the pharmaceutical storage and electronic dispensing carts30 and responsive to the release verification performed by the remotepharmacy pharmacist, can transmit individual facility patientpharmaceutical dispensing instructions to the respective pharmaceuticalstorage and electronic dispensing cart 30 over the communication network18 to thereby initiate patient medication dispensing.

A patient billing tracker 63, responsive to patient medicationdispensing from the respective pharmaceutical storage and electronicdispensing cart 30, can provide separate billing records for each of aplurality of patients at the plurality of long-term care facilities 12.A claims processor 65, responsive to billing records from the patientbilling tracker 63 and a date reference signal, can submit medicationclaims for each patient to either a reimbursement provider or a patientrepresentative, or both. The claims processor 65 can also consolidatebilling data for each long-term care patient, indexed by reimbursementprovider, and submit the medication claims to each respectivereimbursement provider.

An inventory tracker 67 can maintain the medication inventory for eachof the pharmaceutical storage and electronic dispensing carts 30. Aninventory replenisher 69 is positioned to receive the medicationinventory from the inventory tracker 67, and responsive to themedication inventory decreasing below a minimum threshold level, tonotify pharmacy personnel associated with the remote pharmaceuticaldispensing and storage facility 40 of a replenishment requirement for atleast one of the pharmaceutical storage and electronic dispensing carts30.

A medication dispensing apparatus administrator 71, responsive to aninput from pharmacy personnel, can selectively remotely controlfunctions available to facility medical personnel from the terminal ofthe pharmaceutical storage and electronic dispensing cart 30, over thecommunications network, to thereby remotely provide training to thefacility medical personnel. A medication dispensing apparatus imager 73,responsive to video signals from the video input device 31, can displaya video image of facility medical personnel and functional components ofthe pharmaceutical storage and electronic dispensing cart 30 over thecommunications network 18, to also remotely provide training to thefacility medical personnel and for remote, real-time, troubleshootingthe pharmaceutical storage and electronic dispensing cart 30.

It is important to note that although embodiments of the presentinvention have been described in the context of a fully functionalsystem, those skilled in the art will appreciate that the mechanism ofthe present invention and/or aspects thereof are capable of beingdistributed in the form of a computer readable medium of instructions ina variety of forms for execution on a processor, processors, or thelike, and that the present invention applies equally regardless of theparticular type of signal bearing media used to actually carry out thedistribution. Examples of computer readable media include: nonvolatile,hard-coded type media such as read only memories (ROMs) or erasable,electrically programmable read only memories (EEPROMs), recordable typemedia such as floppy disks, hard disk drives and CD-ROMs, andtransmission type media such as digital and analog communication links.

For example, in an embodiment of the present invention, the system 10includes a computer readable medium comprising a set of instructionsthat, when executed by a computer, such as, for example, groupmanagement server 15, remote pharmacy group server 40, or a combinationof the both, cause the computer to establish remote communicationsbetween a remote pharmacy 16 and between each of a plurality ofpharmaceutical storage and dispensing apparatus 30 having a memoryassociated therewith and a plurality of medication dispensingcartridges, to perform instructions to manage pharmaceutical operations.The instructions can include those for registering at least one patientfor each of a plurality of long-term care facilities 12 in a database ofresidents for the long-term care facility 12 associated with apharmaceutical storage and dispensing apparatus 30 located at thatlong-term care facility 12. The instructions include those for receivinga digital image of an actual pharmaceutical prescription ordercontaining patient prescription requirements, queuing the pharmaceuticalprescription order for examination by a remote pharmacy pharmacistassociated with the remote pharmacy 41, analyzing the patientprescription requirements against parameters such as a patientmedication profile, a patient allergy profile, a patient diagnosisprofile, a patient insurance profile, and a drug interaction profile, todetermine if a conflict exists. The instructions can include those forstoring in memory of each pharmaceutical storage and dispensingapparatus 30 at least one medication type, an amount to be dispensed,and a medication dispensing time, and those for maintaining a record ofmedication dispensed and an inventory of medication remaining in eachcartridge of each pharmaceutical storage and dispensing apparatus 30.The instructions can also include those for transmitting the patientprescription requirements to the pharmaceutical storage and electronicdispensing cart 30, and dispensing medication in response to the patientprescription requirements for each patient registered to thepharmaceutical storage and dispensing apparatus 30. The instructions canfurther include those for submitting medication claims to areimbursement provider for each patient, providing separate billingrecords for each registered patient at each of the plurality oflong-term care facilities 12, and consolidating billing data for eachregistered patient at each of the plurality of long-term care facilities12, the billing data preferably indexed by reimbursement provider.

FIG. 8C illustrates the typography of database software according to anembodiment of the present invention. The system user 351 is identifiedby a user ID related to the pharmacy group 353 by a pharmacy group ID. Afacility 355 identified by a facility ID is also related to the pharmacygroup 353 by the pharmacy group ID. A facility drug/medicationdispensing cart 357 is related to the facility 355 by the facility IDand to an individual drug cart 359 (identified by cart ID) by such cartID. A drug cart inventory 361 identified by ndc (National Drug Counsel)and having pharmaceuticals identified by medication ID is related to thedrug cart 359 by the cart ID. A facility formulary 363 is related to thepharmacy group 353 through the preferred drug 365 by the group ID, isrelated to the preferred drug 365 by a medication ID, and is related tothe facility 355 by the facility ID. A pharmacy 367 identified by nabp(National Association of Boards of Pharmacy identification) is relatedto the pharmacy group 353 by the group ID. A patient facility residency369 identified by start date is related to a patient 371 identified bypatient ID by such patient ID and is related to a facility room 373(identified by room number) by such room number. The patient 371 can berelated to the pharmacy group 353 by the group ID. The facility room 373is related to the facility 355 by the facility ID. A patient insurance375 identified by coverage date is related to insurance 377 (identifiedby insurer ID) by such insurer ID, and is related to the patient 371 bythe patient ID. Patient allergy 379 identified by allergy ID, patientdiagnosis 381 identified by icd9 cd (diagnosis profile), and patientmedication profile 383 identified by ndc are each related to patient 371by the patient ID. A prescription 385 identified by script ID is relatedto the pharmacy 367 by the nabp, is related to prescriber 389(identified by prescriber ID) by such prescriber ID, and can be relatedto the patient 371 by the patient ID. Prescription detail 391 identifiedby script fill number is related to the prescription 385 by the scriptID. Claim 393 identified by claim number is related to the prescriptiondetail 391 by the script fill number and to the pharmacy group 353 bythe group ID, is indirectly related to the patient prescription 385 bythe script ID and the pharmacy 367 by the nabp, and can be related tothe patient 371 by the patient ID. A drug utilization review (DUR) 395is related to the prescription 385 by the script ID, the patient 371 bythe patient ID, and is indirectly related to the pharmacy 367 by thenabp. DUR dose check 396, DUR drug allergy 397, DUR dup therapy 398, andDUR drug interaction 399 are identified by drug index number and relatedindirectly through the DUR 395 to the pharmacy 367 by the nabp,prescription 385 by the script ID and patient 371 by the patient ID.Database items (not shown) not having a primary relationship includewholesale drug price identified by ndc, price code, icd9 cd, medicationroa, medication dose form, and medication frequency.

FIG. 9 illustrates a system 10′ of enhanced pharmaceutical operationservices for a long-term care facility 12′ according to an embodiment ofthe present invention that includes an array of incoming data servers, adatabase server, and automated dispensing system servers each having amemory therein to store and process data therein to thereby define along-term care facility pharmacy group management server 15′. Thelong-term care facility pharmacy group management server 15′ can managepharmaceutical operations in various managed care facilities and/orcorrectional facilities, such as, for example, long-term care facility12.′ The long-term care facility 12′ includes at least one, butpreferably a plurality of automated dispensing systems or machines 30′to remotely dispense medications, and a preferably centrally locatedimage capturing device or devices, such as, for example, fax machine 14′and scanner 14″ connected to a workstation computer, to provide an imageof a patient prescription order. The system 10′ additionally can includeat least one but preferably a plurality of remote pharmacy groupcomputers 40′ positioned remote from the long-term care facility 12.′The remote pharmacy group computers 40′ are in communication with thelong-term care facility pharmacy group management server 15′ and theplurality of automated dispensing systems or machines 30,′ through acommunication network, to process the patient prescription orders and toprovide dispensing instructions to the automated dispensing systems ormachines 30′. The remote pharmacy group computers 40′ are preferablylocated in a remote pharmaceutical dispensing and storage facility at alocation remote from both the long-term care facility 12′ and thepharmacy group management server 15.′ Long-term care facility pharmacymanagement software 20 can be stored in the memory of the serversdefining the long-term care facility pharmacy group management server15′ to manage pharmaceutical operations in long-term care facility12.′Further, at least portions of the software 20 can be stored in theremote pharmacy group computers 40′ and in the automated dispensingsystems or machines 30.′

As perhaps best shown in FIG. 6, generally methods of deliveringpharmaceutical operation services have three main components forimplementation, namely restructuring communication methods andintervals, automating medication procurement and distribution, andevaluation of routine, e.g., weekly, visits to assess system performanceand maintenance. When a long-term care facility 12 desires to implementan embodiment of a system 10 (FIGS. 1A-1B) to enhance pharmaceuticaloperations, a transition team from the remote pharmacy staff, forexample, or from a combination of remote pharmacy staff and long-termcare facility staff, for example, can be used to assist in changing theexisting procedures of using pharmaceutical services and dispensingmedications for the long-term care facility 12 and in implementing thenew system 10, software 20, and methods of embodiments of the presentinvention.

Restructuring communication methods and intervals, for example, caninclude installing (block 101) facsimile, scanning, or other documentprocessing equipment 14 (FIG. 3) to scan physician prescription ordersand to transmit them to the remote pharmacy group server 40 or thepharmacy group management server 15 via a virtual private network(“VPN”) 18 (see FIG. 7). Medication errors can be reduced when thepharmacy staff at the remote pharmacy view exact images of orders (seealso FIGS. 8A-8B). Voice communication over telephone lines can be errorprone due to language barriers and transcription errors. Direct imagingallows the pharmacist to interpret the medication orders in the same wayas the facility staff. Should an error be made, then one of thehealthcare professionals is more likely to discover the error if directimaging is in place. For example, allowing the pharmacist to read a copyof the original document insures that at least two healthcareprofessionals have reviewed the order, namely the nurse and thepharmacist. These separate order reviews lead to separate documentationby the nurse and the pharmacist. If these two document sources do notmatch, then the nurse and pharmacist can discuss the order and clarifywith the prescriber, if necessary.

The methods also supply long-term care facility staff with the trainingand tools (block 103) to allow the remote pharmacy to communicate withthe facility 12 at the end of each medication administration intervalfor administration of medication to the residents of the long-term carefacility 12. Because the communication is built into or included withthe medication distribution procedures, the tools, for example, allowthis communication to occur frequently and without requiring additionalfacility staff time. More frequent communications allow the system 10,software 20, and methods to reduce errors due to miscommunication andmisinterpretation of medication orders, and tools such as medicationpass lists (not shown) and new or changed order reports (not shown), asunderstood by those skilled in the art, result in better synchronizationbetween the pharmacy and the facility documentation. Medication passlists are generally utilized to document delivery of medication to apatient and include the time, quantity, method of dispensing, and healthprofessional dispensing the medication. By supplying or communicatingsuch medication pass lists to the pharmacist, the pharmacist is provideda unique methodology to determine if the medication was dispensedaccording to instructions provided to the pharmaceutical storage anddispensing apparatus 30 and if the medication distribution proceduresare being adhered too. New or changed order reports are generally usedto document changes in a patient medication order and include changes inthe time, quantity, or method of dispensing medication. By supplying orcommunicating such changed order report to the pharmacist, thepharmacist is provided yet another methodology of determining if themedication dispensing instructions provided to the pharmaceuticalstorage and dispensing apparatus 30 coincide with that which thefacility medical personnel believe to be the instructions provided bythe patient prescription order. Any discrepancy can be discussed betweenpharmacy member and facility medical personnel, enhancing qualitycontrol. Advantageously, use of standardized medication pass lists andnew or changed order reports provided or approved by the pharmacy allowsenhanced communication between pharmacy and facility medical personnel,not otherwise available if the pharmacy had to review medication passlists and new or changed order reports having a different format foreach long-term care facility 12.

Further, remote pharmacy personnel, through the long-term care facilitypharmacy group management server 15 or a remote pharmacy group server40, can dial-up or otherwise remotely access the dispensing cart 30through the communication network 18 and perform virtual “face-to-face”training of facility medical personnel along with other tasks such as,troubleshooting, packaging medications, and all other functions that canbe performed by the dispensing cart 30, itself. In an embodiment of thepresent invention having video input device 31 (FIG. 2), this virtual“face-to-face” can further be in the form of a videoconference,including audio communications, whereby pharmacy personnel can monitorinstantaneously the actions of the facility medical personnel to providereal-time feedback and to verify results of actions taken by thefacility medical personnel or functions performed by the dispensing cart30. These features provide the facility medical personnel real-time helpin learning and operating the dispenser cart 30 which advantageouslyprovides for an acceptance level not attainable where such real-timesupport 24/7 is not available. Note, the video input device 31 can bemounted either to the dispensing cart 30 or adjacent the dispensing cart30 such that pharmacy personnel can readily view, and thus helpinstruct, actions by facility medical personnel. In an embodiment of thepresent invention, the video input device 31 can include hardware suchas, for example, servo motors, that will allow the device 31 to beremotely controlled to change viewing angle, to change focus, or to zoomin or out to better view the facility medical personnel or components ofthe dispensing cart 30.

Likewise, within the remote pharmacy facility, the pharmacy managementsoftware 20 can be networked to communicate with both the long-term carefacility document processor 14, e.g., fax machine, scanner, or imagecapture device, and the pharmaceutical storage and dispensing machinesor cart 30, and the optional video input device 31, at the long-termcare facility 12 (block 105). The software 20 and methods can beconfigured (block 107) to manage information flow on the VPN 18 betweenthe long-term care facility document processor 14, long-term carefacility pharmaceutical storage and dispensing machines or cart 30, andone or more pharmacy database 22 associated with the software 20. Thesoftware 20 and methods, thus, allow the remote pharmacy and thelong-term care facility 12 to communicate in real time or near real timeand provide near real time medication fulfillment for the long-term carefacility residents. The software 20 and methods also can manage anunlimited number of long-term care facilities 12 (for example, via aplurality of remote pharmacy groups (see FIG. 1A-1B)) within embodimentsof the system 10 of the present invention and can be assessed/managed byremote pharmacy staff by use of the VPN.

For automating medication procurement and distribution, for example, thetransition team can aid in restructuring the medication administrationintervals (block 109) to accommodate more of a just-in-time medicationprocurement system to significantly reduce waste and risk of errors (seealso FIG. 5). The medication intervals can be combined into apreselected number of medication pass time blocks (block 111), e.g.,four pass times (breakfast 2400-0600, AM 0600-1030, Noon 1030-1430, andHS 1830-2400). Each block of time has specific medication administrationtimes within the block (see also FIG. 5). Once time blocks areestablished, these time blocks are programmed (blocks 113 and 115) intothe pharmaceutical storage and dispensing machines or carts 30 so thatpharmaceuticals or medications (FIG. 4B) are packaged by physicallocation within the long-term care facility 12 and by time block andloaded into caddies or trays 35 (FIG. 4A) associated with the dispensingcarts 30. This procurement method significantly reduces long-term carefacility staff time spent on medication procurement, e.g., by up to 50%,and reduces medication errors. Long-term care facility staff can betaught (block 117) how to produce medication lists for each time block.The medication list is used as a road map for the medicationadministration interval and can be transmitted via the VPN 18 to theremote pharmacy. This method enhances communication by requiring orinsuring communication between the remote pharmacy staff and thelong-term care facility staff at least four times per day with littleadded time commitment by either party.

Additionally, the transition team can meet with facility physicians toestablish a type of automated therapeutic exchange protocol (block 119).This protocol can be managed by the remote pharmacy management software20 and allows the long-term care facility and remote pharmacy to manageformulary management programs through the VPN 18 in a real time or nearreal time manner. The therapeutic exchange protocol streamlines theinventory of each of the plurality of pharmaceutical storage andelectronic dispensing carts 30, reduces wasted medication, and reducescosts for payors.

Further, periodic or preselected visits (block 121) to each long-termcare facility within the system 10 to assess system performance andmaintenance can be conducted by the remote pharmacy staff. This canenhance communication and enhance performance assessments within thesystem 10. Dispensing carts 30, document processors 14, software 20,medication inventory, and other elements of the system 10 also can bemaintained during these visits as well. For example, medications thatcannot be packaged by a pharmaceutical storage and electronic dispensingcart 30 can be reviewed and reordered, if needed.

As perhaps best shown in FIGS. 7-8B, in operation, to start newmedications nurses can have first dose privileges. If a medication isfor a new resident in the long-term care facility 12, then the remotepharmacy or an on-call pharmacist can be notified so the resident can beadded to a database 22 of residents for the particular long-term carefacility 12 associated with the pharmaceutical storage and dispensingcart 30 located at that facility. A pharmacist at the remote pharmacycan enter prescription information from a faxed or scanned physician'sorder into the pharmacy group management software 20. More specifically,the pharmacist receives the digital faxed/scanned image (block 131) ofthe prescription for a patient. Based upon the information provided withthe prescription, the pharmacist then enters into the software 20 thelocation of a remote pharmacy (block 133), the name of or identificationfor the facility (block 135), the patient information (block 137), andthe preferred drug (block 139). The pharmacist further enters (block141) details of dosage, route of administration, frequency and durationof the prescription. The pharmacist further enters (block 143) thequantity to be dispensed and prescribing physician information.

The software 20 can then perform (block 145) a drug utilization review(see also FIG. 7). The above described information is then sent to achecking queue (block 147) whereby the pharmacist checks (block 149) thephysical prescription for correctness. The software 20 then candetermine if the drug to be dispensed is in stock in the pharmaceuticalstorage and dispensing cart 30. If the software 20 determines that themedication is stocked in the dispensing cart 30, then it can send theprescription information to the dispensing cart 30 (block 151) insteadof printing a traditional prescription label. The cart 30 can thendispense the medication during the scheduled administration time. If themedication is not stocked in the dispensing cart 30, then a prescriptionlabel can be produced. The prescription can then be filled and deliveredin a traditional way to the long-term care facility 12, e.g., by thevehicle V. The traditional way, for example, can also be used fornon-oral solid medication such as liquids, creams, inhalers, andinjectables as well, e.g., daily deliveries, as the pharmaceuticalstorage and electronic dispensing carts 30 often do not dispense theseitems.

Advantageously, embodiments of the present invention also includemethods of increasing or generating revenue from a plurality oflong-term care facilities 12 being devoid of an on-location pharmacy.For example, as perhaps best shown in FIG. 11, a method includes thesteps of providing a pharmacy remote from a plurality of long-term carefacilities (block 161) to define a long-term care facility remotepharmacy 41, positioning at least one pharmaceutical storage anddispensing apparatus 30 in each of the plurality of long-term carefacilities 12 (block 163) to store and dispense pharmaceuticals to apatient living therein, each apparatus 30 preferably having at least oneremovable medicine cartridge. Remote communications are established(block 165) between each pharmaceutical storage and dispensing apparatus30 and the remote pharmacy 41. Patients can then be registered (block167) for each of the plurality of long-term care facilities 12 in adatabase of residents of the long-term care facility 12 associated witha respective pharmaceutical storage and dispensing apparatus 30, thedatabase preferably stored in memory 21 of a data processing andmanagement computer, such as, for example group management server 15. Atleast one medication type and amount to be dispensed (block 169) and amedication dispensing time (block 171) can be remotely programmed intoeach pharmaceutical storage and dispensing apparatus 30. Medication isthen dispensed (block 173) according to patient prescriptionrequirements for each associated registered patient. An inventory ismaintained (block 175) of the medication dispensed and medicationremaining in the pharmaceutical storage and dispensing apparatus.Advantageously, the method can include providing separate billingrecords (block 177) for each of the patients at each of the plurality oflong-term care facilities 12. Billing data can then be consolidated foreach of the patients (block 179) at each of the plurality of long-termcare facilities. Medication claims can then be submitted to areimbursement provider (block 181) organized by patient, grouped intocategories, supplied in a batch form for each registered patient.

Also for example, as perhaps best shown in FIGS. 12A-C, a method ofgenerating revenue from a plurality of long-term care facilities eachdevoid of an on-location pharmacy generally includes the steps ofreducing management overhead costs (block 200), reducing pharmaceuticaldelivery costs (block 220), reducing pharmaceutical error costs andliabilities due to miscommunication and misinterpretation of apharmaceutical prescription order (block 230), maintaining automatedpharmaceutical storage and dispensing cart operational status (block240), streamlining long-term care facility medication dispensingprocedures (block 250), and preventing prescription backlogs (block260).

Management overhead costs can be reduced by assigning each of theplurality of long-term care facilities 12 at least one automatedpharmaceutical storage and dispensing cart 30 (block 201), assigning aplurality of the long-term care facilities 12 to each of at least onelong-term care facility remote pharmacy 41 (block 203), and assigningthe at least one long-term care facility remote pharmacy 41 to a singlelong-term care facility pharmacy group manager (block 205). Thishierarchal management and supply structure allows pharmacy groupmanagement to continuously monitor multiple long-term care facilities 12for a preselected region and to provide real-time management ofpharmaceutical distribution and resupply. Further, costs can be reducedby remotely providing training (block 207) by selectively remotelycontrolling functions available to a facility staff member from aterminal of the pharmaceutical storage and electronic dispensing cart 30over a communications network 18. This allows for the provision of avirtual on-site face-to-face training session to help a facility staffmember having difficulties interfacing with the pharmaceutical storageand dispensing cart 30, thus preventing the need for an actual on-sitevisit and allowing provision of such service 24 hours a day, 7 days aweek, generally not otherwise available. Training of facility staffmembers can be enhanced (block 209) by providing pharmacy personnel withaudio and with visual feedback through a video input device 31 (FIG. 2)positioned adjacent to and preferably interfaced with the pharmaceuticalstorage and electronic dispensing cart 30 and positionable to displayover the network 18 a video image of the facility staff member. Costscan further be reduced through the use of software 20 that can interfacewith the pharmaceutical storage and electronic dispensing cart 30 toboth providing separate billing records for a plurality of patients ateach of the plurality of long-term care facilities (block 211), andgenerate reimbursements from a reimbursement provider electronically(block 213). The reimbursements can be generated by consolidatingbilling data for a plurality of patients at each of the plurality oflong-term care facilities 12 (block 215) for submission to a respectivesame reimbursement provider, followed by submitting medication claimselectronically (block 217) to each respective reimbursement provider foreach of the plurality of patients. This allows for efficient batch-typeprocessing of patient claims by each reimbursement provider.

Pharmaceutical delivery costs can be reduced through the use of adedicated remote pharmacy vehicle V for delivering pharmaceuticals tomultiple long-term care facilities 12 to resupply each facilitiespharmaceutical storage and dispensing carts 30 and to provide thosepharmaceuticals according to the patient prescription requirements andnot provided by each respective pharmaceutical storage and electronicdispensing cart 30, preferably all in a single delivery iteration. Thisallows for establishing regular delivery routes resulting in efficientuse of the vehicular asset and pharmacy personnel.

Pharmaceutical error costs and liabilities due to miscommunication andmisinterpretation of a pharmaceutical prescription order can be reducedthrough use of a procedure whereby instead of having facility staffmembers review a physician's prescription order and transmit extractedinformation, facility staff members can transmit an exact image of eachphysician's pharmaceutical prescription order (block 231) from apharmaceutical document processor 14 associated with a pharmaceuticalstorage and electronic dispensing cart 30 over the network 18 to arespective long-term care facility remote pharmacy 41. This procedureallows for establishment of a quality assurance check (block 233)whereby both the facility staff member and the remote pharmacist canboth review the original or an exact image of the original physician'spharmaceutical prescription order. This redundancy reduces errors ininterpretation of the physician's prescription order. Patientprescription requirements can then be analyzed (block 235) against apatient medication profile, a patient allergy profile, a patientdiagnosis profile, a patient insurance profile, and a drug interactionprofile, to determine if a conflict exists. Further, a standardizedMedication Pass List (not shown) and a New or Changed Order Report (notshown) can be provided (block 237) to synchronize pharmacy and long-termcare facility documentation. This synchronization prevents waste andhelps ensure accountability.

Maintaining operational status of an automated pharmaceutical storageand dispensing cart 30 can be an extremely significant issue in anautomated pharmaceutical dispensing operation. In the preferredembodiment of the present intention, pharmacy staff members rather thanfacility staff members are assigned a primary responsibility to monitorusage, restocking, and maintenance of the pharmaceutical storage anddispensing cart 30 (block 241). Establishing accountability for thecarts 30 with pharmacy personnel has led to significant improvements inoperational status. Further, implementing a procedure whereby pharmacypersonnel can remotely troubleshoot over the communication network 18(block 243) a visually accessible functional component of thepharmaceutical storage electronic dispensing cart 30 with use of a videoinput device 31 (FIG. 2) positioned adjacent to and preferablyinterfaced with the pharmaceutical storage and electronic dispensingcart 30. In an embodiment of the present invention, the video inputdevice 31 can be connected to or adjacent the pharmaceutical storage andelectronic dispensing cart 30 via a flexible and/or snake mount or othersuitable connection known to those skilled in the art, such as, forexample, a USB cable, telephone cable, coaxial cable, optical cable, orwireless transceiver. The video input device 31 can thus be positionableby facility staff members or other personnel to display a real-timevideo image of the visually accessible functional component of thepharmaceutical storage and electronic dispensing cart 30, allowing forreal-time troubleshooting of the cart 30. Further, the video inputdevice 31, can be remotely controlled to change viewing angle, to changefocus, or to zoom in or out to better view the component or componentsof interest and to monitor actions of the facility medical personnel orother on-station pharmacy personnel requested to move a panel orcomponent or to perform the repair. This allows pharmacy personnel tomaintain supervision and thus control, over any non-standard mechanicalmanipulation or repair of the cart 30.

Streamlining long-term care facility medication dispensing procedurescan be accomplished by consolidating medication intervals (block 251).In the preferred embodiment of the present intention, medicationintervals are consolidated into four medication pass time blocks, eachblock having specific medication administration times within therespective block. This has resulted in improved medication dispensingefficiency, reduced facility staff member workload and potentiallysignificantly reduced costs for the long-term care facility 12, andthus, an increase in acceptance of the pharmaceutical storage andelectronic dispensing carts 30.

An inherent problem with having to receive electronic images of thephysician's prescription order is the potential for a backlog due toprescription order entry difficulties. Due to the reduced number ofmedication pass time blocks, receiving and processing prescriptionorders can be time critical. In a just-in-time type system, aprescription order entry difficulty caused by as little as a singleentry problem could potentially cause a late arrival of the prescriptionorder resulting in a late delivery of patient medication. Institution ofa maximum individual order entry time protocol (block 261) prevents suchprescription backlogs due to prescription order entry difficulties. Thisprotocol allows the remote pharmacy 41 to accommodate massive numbers ofincoming prescription orders.

As illustrated in FIGS. 1-12C, and as described above, embodiments ofthe present invention includes a method of providing pharmaceuticalservices to long-term care facilities 12 including providing a pharmacyremote from a plurality of long-term care facilities 12 to define along-term care facility remote pharmacy, restructuring long-term carefacility staff procedures for communication between the long-term carefacility staff and the long-term care facility remote pharmacy,restructuring medication procurement and resident medicationdistribution procedures within a plurality of long-term care facilities,installing a pharmaceutical storage and electronic dispensing machine orcart 30 at each of the plurality of long-term care facilities 12 to beused by the long-term care facility staff, and visiting each of theplurality of long-term care facilities 12 on a preselected frequency,e.g., from the remote pharmacy, to assess performance and enhancecommunication.

By implementing these methods, a system 10, and software 20 ofembodiments of the present invention, shift-change medication counts canbe eliminated or significantly reduced, medication preparation and passtimes can be reduced, and drug/medication destruction can besignificantly reduced. Also, long-term care facility staff can have morefree time due to the planning and implementation of a structureprocedure of embodiments of the present invention. In turn, care of theresidents can be enhanced by allowing staff to have more time for careof residents instead of on medication preparation and passing time,documentation can be improved, risk of liabilities can be reduced, riskof errors and stolen medications can be reduced, and communicationbetween long-term care facility staff and pharmacy staff can beenhanced. Additionally, embodiments of a system 10, software 20, andmethods allow a long-term care facility 12 to reduce operational costsand staffing, if desired. In turn, residents and payors can save money,and residents can have better care.

This application is a continuation of U.S. patent application Ser. No.15/077,403, filed Mar. 22, 2016, titled “System of Enhanced Distributionof Pharmaceuticals in Long-Term Care Facilities,” which is acontinuation of U.S. patent application Ser. No. 15/001,498, filed Jan.20, 2016, titled “System and Method of Enhanced Distribution ofPharmaceuticals in Long-Term Care Facilities,” which is a continuationof U.S. patent application Ser. No. 14/589,174, filed Jan. 5, 2015,titled “System And Method Of Enhanced Distribution Of Pharmaceuticals InLong-Term Care Facilities,” which is continuation of U.S. patentapplication Ser. No. 14/075,461, filed Nov. 8, 2013, now U.S. Pat. No.8,954,338, issued Feb. 10, 2015, titled “System And Method Of EnhancedDistribution Of Pharmaceuticals In Long-Term Care Facilities,” which isa continuation of U.S. patent application Ser. No. 14/014,796, filedAug. 30, 2013, now U.S. Pat. No. 8,612,256, issued Dec. 17, 2013, titled“System And Software Of Enhanced Pharmaceutical Operations In Long-TermCare Facilities And Related Methods” which is a continuation of U.S.patent application Ser. No. 13/725,432, filed Dec. 21, 2012, now U.S.Pat. No. 8,554,574, issued Oct. 8, 2013, titled “System And Software OfEnhanced Pharmaceutical Operations In Long-Term Care Facilities AndRelated Methods” which is a divisional of U.S. patent application Ser.No. 13/454,624, filed Apr. 24, 2012, now U.S. Pat. No. 8,489,425, issuedJul. 16, 2013, titled “System and Software of Enhanced PharmaceuticalOperations in Long-Term Care Facilities and Related Methods,” which is acontinuation of U.S. patent application Ser. No. 11/818,416, filed Jun.14, 2007, now U.S. Pat. No. 8,260,632, issued Sep. 4, 2012, titled“System and Software of Enhanced Pharmaceutical Operations in Long-TermCare Facilities and Related Methods,” which is a divisional of U.S.patent application Ser. No. 10/944,993, filed Sep. 20, 2004, now U.S.Pat. No. 7,698,019, issued Apr. 13, 2010, titled “System and Software ofEnhanced Pharmaceutical Operations in Long-Term Care Facilities andRelated Methods,” which claims priority of U.S. Provisional ApplicationSer. No. 60/516,678, filed Nov. 3, 2003, titled “System and Software ofEnhanced Pharmaceutical Operations in Long-Term Care Facilities andRelated Methods,” each incorporated herein by reference in its entirety.

Many modifications and other embodiments of the invention will come tothe mind of one skilled in the art having the benefit of the teachingspresented in the foregoing descriptions and the associated drawings.Therefore, it is to be understood that the invention is not to belimited to the illustrated embodiments disclosed, and that modificationsand other embodiments are intended to be included within the scope ofthe appended claims.

That claimed is:
 1. A method to facilitate enhanced use of two or morepharmaceutical storage and electronic dispensing machines for use withtwo or more corresponding long-term care facilities when incommunication with a communications network and one or more remotelong-term care facility pharmacy management servers, the methodcomprising: positioning two or more pharmaceutical storage andelectronic dispensing machines each to be located at one of two or morecorresponding different long-term care facilities, each of the two ormore pharmaceutical storage and electronic dispensing machines alsobeing positioned to package medications stored in each of the two ormore pharmaceutical storage and electronic dispensing machines into aplurality of disposable patient dosing packages, each of the two or morepharmaceutical storage and electronic dispensing machines also beingremote from, and in communication with, one or more long-term carefacility pharmacy management servers associated with a long-term carefacility remote pharmacy via a communications network, each of the twoor more corresponding different long-term care facilities also beingremote from the long-term care facility remote pharmacy, the one or morelong-term care facility pharmacy management servers includingnon-transitory, tangible memory medium to store long-term care facilitymanagement computer programs, the long-term care facility managementcomputer programs being operable on the one or more long-term careservers to perform the following steps: receiving one or more patientmedication prescription orders, and selectively remote controllingfunctional operations of the two or more pharmaceutical storage andelectronic dispensing machines; the long-term care facility managementcomputer programs also being configured and operable to perform thesteps of: electronically verifying, at the long-term care facilityremote pharmacy, the one or more patient medication prescription orderswhen positioned in communication with the two or more pharmaceuticalstorage and electronic dispensing machines, electronically comparing theone or more patient medication prescription orders with one or more of apatient medication profile, a patient diagnosis profile, and a druginteraction profile, determining, responsive to the one or more patientmedication prescription orders, whether one or more drug conflictsexist; transmitting package and dispense instructions to one of the twoor more pharmaceutical storage and electronic dispensing machines viathe communications network when no drug conflicts exist to therebyinitiate packaging and dispensing of one or more disposable patientdosing packages at the one of the two or more pharmaceutical storage andelectronic dispensing machines; and packaging and dispensing, responsiveto the transmitted package and dispense instructions, one or moreindividual doses of disposable patient dosing packages at the one of thetwo or more pharmaceutical storage and electronic dispensing machines.2. A method as defined in claim 1, wherein each of the two or morepharmaceutical storage and electronic dispensing machines each includesa plurality of removable medication cartridges, each of the plurality ofremovable medication cartridges associated with an individualmedication.
 3. A method as defined in claim 1, wherein the long-termcare facility management computer programs further include instructionsto provide remote training to one or more long-term care facility staffmembers by selectively remotely controlling one or more functions,available to the one or more long-term care facility staff members froma terminal of each of the two or more pharmaceutical storage andelectronic dispensing machines, by the long-term care facilitymanagement computer programs via the communications network responsiveto input received from the one or more long-term care facility remotepharmacy personnel.
 4. A method as defined in claim 1, wherein the twoor more pharmaceutical storage and electronic dispensing machines eachare further in communication with one or more video devices, and whereinthe long-term care facility management computer programs further includeinstructions to display, at the long-term care facility remote pharmacy,one or more video images of at least one visually accessible functionalcomponent of each of the two or more pharmaceutical storage andelectronic dispensing machines over the communications network toprovide remote troubleshooting of the two or more pharmaceutical storageand electronic dispensing machines.
 5. A method as defined in claim 1,wherein the long-term care facility management computer programs arefurther configured and operate to verify one or more changed orderreports when received from one or more pharmaceutical prescriptiondocument processors to thereby further enhance reduction of medicationorder errors, the one or more changed order reports configured toindicate changes in time, quantity, or method of dispensing individuallypackaged pharmaceuticals associated with the one or more patientmedication prescription orders.
 6. A method as defined in claim 1,wherein the one or more patient medication prescription orders isreceived from one or more pharmaceutical prescription documentprocessors, and wherein receipt of the one or more patient medicationprescription orders includes receipt of a predetermined physician'sprescription order associated with each of the one or more medicationprescription orders.
 7. A method as defined in claim 1, wherein thelong-term care facility management computer programs are also configuredand operable to perform the step of initiating packaging and dispensingof the one or more disposable patient dosing packages at the one of thetwo or more pharmaceutical storage and electronic dispensing machines.8. A method to facilitate enhanced use of two or more pharmaceuticalstorage and electronic dispensing machines for use with two or morecorresponding long-term care facilities when in communication with acommunications network and one or more remote long-term care facilitypharmacy management servers, the method comprising: positioning two ormore pharmaceutical storage and electronic dispensing machines each tobe located at one of two or more corresponding different long-term carefacilities, each of the two or more pharmaceutical storage andelectronic dispensing machines also being positioned to package aplurality of disposable patient dosing packages of medications storedtherein, each of the two or more pharmaceutical storage and electronicdispensing machines also being remote from, and in communication with,one or more long-term care facility pharmacy management serversassociated with a long-term care facility remote pharmacy via acommunications network, each of the two or more corresponding differentlong-term care facilities also being remote from the long-term carefacility remote pharmacy, the one or more long-term care facilitypharmacy management servers including non-transitory, tangible memorymedium to store long-term care facility management computer programs,the long-term care facility management computer programs being operableon the one or more long-term care servers to perform the followingsteps: receiving one or more patient medication prescription orders, andselectively remote controlling functional operations of the two or morepharmaceutical storage and electronic dispensing machines; the long-termcare facility management computer programs also being configured andoperable to perform the steps of: electronically verifying, at thelong-term care facility remote pharmacy, the one or more patientmedication prescription orders when positioned in communication with thetwo or more pharmaceutical storage and electronic dispensing machines;electronically comparing the one or more patient medication prescriptionorders with one or more of a patient medication profile, a patientdiagnosis profile, and a drug interaction profile; determining,responsive to the one or more patient medication prescription orders,whether one or more drug conflicts exist; and initiating packaging anddispensing of one or more disposable patient dosing packages at the oneof the two or more pharmaceutical storage and electronic dispensingmachines responsive to dispense instructions.
 9. A method as defined inclaim 1, wherein each of the two or more pharmaceutical storage andelectronic dispensing machines each includes a plurality of removablemedication cartridges, each of the plurality of removable medicationcartridges associated with an individual medication.
 10. A method asdefined in claim 1, wherein the long-term care facility managementcomputer programs further include instructions to provide remotetraining to one or more long-term care facility staff members byselectively remotely controlling one or more functions, available to theone or more long-term care facility staff members from a terminal ofeach of the two or more pharmaceutical storage and electronic dispensingmachines, by the long-term care facility management computer programsvia the communications network responsive to input received from the oneor more long-term care facility remote pharmacy personnel.
 11. A methodas defined in claim 1, wherein the two or more pharmaceutical storageand electronic dispensing machines each are further in communicationwith one or more video devices, and wherein the long-term care facilitymanagement computer programs further include instructions to display, atthe long-term care facility remote pharmacy, one or more video images ofat least one visually accessible functional component of each of the twoor more pharmaceutical storage and electronic dispensing machines overthe communications network to provide remote troubleshooting of the twoor more pharmaceutical storage and electronic dispensing machines.
 12. Amethod as defined in claim 1, wherein the long-term care facilitymanagement computer programs are further configured and operate toverify one or more changed order reports when received from one or morepharmaceutical prescription document processors to thereby furtherenhance reduction of medication order errors, the one or more changedorder reports configured to indicate changes in time, quantity, ormethod of dispensing pharmaceuticals associated with the one or morepatient medication prescription orders.
 13. A method as defined in claim1, wherein the one or more patient medication prescription orders arereceived from one or more pharmaceutical prescription documentprocessors, and wherein receipt of the one or more patient medicationprescription orders includes receipt of a predetermined physician'sprescription order associated with each of the one or more medicationprescription orders.